Di Nardo G, Di Lorenzo C, Lauro A, Stanghellini V, Thapar N, Karunaratne T B, Volta U, De Giorgio R
Pediatric Unit, Orvieto Hospital, Orvieto, Italy.
Pediatric Gastroenterology Unit, International Hospital Salvator Mundi, Rome, Italy.
Neurogastroenterol Motil. 2017 Jan;29(1). doi: 10.1111/nmo.12945. Epub 2016 Sep 29.
Chronic intestinal pseudo-obstruction (CIPO) represents the most severe form of gastrointestinal dysmotility with debilitating and potentially lethal consequences. Symptoms can be non-specific, and result in this condition being diagnosed incorrectly or too late with consequences for morbidity and even mortality.
The present article aims to provide pediatric and adult gastroenterologists with an up to date review about clinical features, diagnosis and therapeutic options for CIPO. Although pediatric and adult CIPO share many clinical aspects distinctive features can be identified. There is no single diagnostic test or pathognomonic finding of CIPO, thus a stepwise approach including radiology, endoscopy, laboratory, manometry, and histopathology should be considered in the diagnostic work-up. Treatment of patients with CIPO is challenging and requires a multidisciplinary effort with participation of appropriately experienced gastroenterologists, pathologists, dieticians, surgeons, psychologists, and other subspecialists based on the presence of comorbidities. Current treatment options invariably involve surgery and specialized nutritional support, especially in children. Medical therapies are mainly aimed to avoid complications such as sepsis or intestinal bacterial overgrowth and, where possible, restore intestinal propulsion. More efficacious therapeutic options are eagerly awaited for such difficult patients.
慢性假性肠梗阻（CIPO）是胃肠动力障碍最严重的形式，会导致衰弱甚至可能致命的后果。症状可能不具特异性，导致该病被误诊或诊断过晚，从而影响发病率甚至死亡率。
本文旨在为儿科和成人胃肠病学家提供关于CIPO临床特征、诊断和治疗选择的最新综述。虽然儿科和成人CIPO有许多共同的临床方面，但也可发现一些独特特征。CIPO没有单一的诊断测试或特征性表现，因此在诊断检查中应考虑采用包括放射学、内镜检查、实验室检查、测压和组织病理学的逐步方法。CIPO患者的治疗具有挑战性，需要多学科合作，根据合并症情况，由经验丰富的胃肠病学家、病理学家、营养师、外科医生、心理学家和其他专科医生参与。目前的治疗选择总是涉及手术和专门的营养支持，尤其是在儿童中。药物治疗主要旨在避免诸如败血症或肠道细菌过度生长等并发症，并在可能的情况下恢复肠道推进功能。对于这类难治性患者，人们急切期待更有效的治疗选择。
